Provider Demographics
NPI:1487268314
Name:BICKNELL, MADELINE
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:BICKNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 E 9TH AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3907
Mailing Address - Country:US
Mailing Address - Phone:303-372-7030
Mailing Address - Fax:
Practice Address - Street 1:4545 E 9TH AVE STE 10
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3907
Practice Address - Country:US
Practice Address - Phone:303-372-7030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical